Healthcare Provider Details

I. General information

NPI: 1477628063
Provider Name (Legal Business Name): THERESA L CUEVAS C.F.N.P.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 BROAD AVENUE SUITE 600
GULFPORT MS
39501
US

IV. Provider business mailing address

3322 W END AVE 11TH FLOOR
NASHVILLE TN
37203-1031
US

V. Phone/Fax

Practice location:
  • Phone: 228-284-1634
  • Fax: 228-284-1635
Mailing address:
  • Phone: 615-515-9880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR850390
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: